Understanding Medical Billing-Part 1 Medical Insurance Steps Video

Video Transcription

Video Summary

In this video, Alex Vaughn introduces himself as an oral facial pain specialist and a coding lay expert. He explains that the video will review how medical insurance works, including eligibility, medical necessity, and payment. He emphasizes that medical insurance should be thought of as three separate companies, each with their own rules and processes. Vaughn discusses the importance of understanding insurance policies and coverage guidelines for different medical procedures. He also explains the appeal process and the necessity of having the right goal for each appeal. Vaughn suggests conducting a benefits check to determine coverage, deductibles, and co-pays. He advises looking for insurance policies online using specific codes and keywords. Vaughn also explains the different arrangements for accepting assignment, in-network and out-of-network statuses, as well as gap exceptions and single case agreements. He highlights the importance of tracking payments using a W-9 form, and discusses the options of receiving payments via check or electronic funds transfer. An electronic remittance advice (ERA) is also mentioned as a tool that provides information on the insurance's payment details.

Keywords

medical insurance

coverage guidelines

appeal process

benefits check

specific codes

in-network

electronic remittance advice